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Published on: March 27, 2012
Child and Family Characteristics Associated With Age of Autism Spectrum Disorder Diagnosis in a Primary Care
Corinna J Rea1,2, Kayla Lesch1, Barbara Hernandez1
1Division of General Pediatrics, Boston Children's Hospital, Boston, MA.
Insights
Autism spectrum disorder (ASD) is more common in males and Hispanic children, with earlier diagnosis linked to early intervention and continuous care. However, disparities persist for publicly insured children, emphasizing the need for prompt diagnosis support.
Area of Science:
- Pediatric Healthcare
- Developmental Pediatrics
- Autism Spectrum Disorder Research
Background:
- Autism Spectrum Disorder (ASD) diagnosis in pediatric primary care settings requires understanding population characteristics and factors influencing diagnostic timeliness.
- Previous research indicates potential disparities in ASD diagnosis based on socioeconomic and demographic factors.
Purpose of the Study:
- To compare the demographic and clinical characteristics of pediatric patients diagnosed with ASD against the general clinic population.
- To identify child and caregiver factors associated with the age of ASD diagnosis in a primary care setting.
Main Methods:
- A cross-sectional study analyzed medical records of pediatric patients diagnosed with ASD from two urban primary care practices (March 2018-February 2022).
- Statistical analyses included chi-square tests for population comparison and linear regression models to assess associations with age of diagnosis.
Main Results:
- Patients with ASD were more likely to be male, Hispanic, publicly insured, and medically complex, with higher maternal education.
- Factors associated with earlier ASD diagnosis included language delay, early intervention (EI) connection, earlier parental concern, higher M-CHAT scores, and better continuity of care.
- Race/ethnicity, language, and high Social Vulnerability Index were not significantly associated with age of ASD diagnosis.
Conclusions:
- The study highlights evolving ASD prevalence patterns and persistent diagnostic age disparities for publicly insured children.
- Emphasizes the critical role of developmental monitoring, consistent healthcare, and navigation support for timely ASD diagnosis.
Objective:
To compare a sample of pediatric primary care patients diagnosed with autism spectrum disorder (ASD) with the general clinic population, as well as associations of child and caregiver characteristics with age of diagnosis.
Method:
Cross-sectional data for patients from 2 large, urban primary care practices diagnosed with ASD between March 1, 2018, and February 28, 2022, were collected from the medical record through extraction and chart review. The sample was compared with the total primary care population using χ 2 analysis. Unadjusted bivariate linear regression and multivariate linear regression were used to evaluate associations of each variable with age of diagnosis.
Results:
Patients diagnosed with ASD were more likely to be male, Hispanic, publicly insured and medically complex than the general clinic population. There was also a higher maternal education level in the autism group. In unadjusted linear regression analyses, language delay, connection with Early Intervention (EI), earlier age of parental concern, earlier age of referral, having an M-CHAT completed, higher M-CHAT scores, and having a first-degree relative with ASD were associated with earlier age of diagnosis. In multivariate linear regression analysis, connection with EI, better continuity of care, higher M-CHAT scores and having commercial insurance were associated with earlier diagnosis. Race/ethnicity, language, and Social Vulnerability Index ≥ 90%ile were not significantly associated with age of ASD diagnosis.
Conclusion:
This study reflects shifting prevalence patterns of ASD, but a persistent disparity in age of diagnosis among publicly insured children. It highlights the importance of developmental monitoring, continuity of care, and navigation support to help families obtain ASD diagnoses promptly.
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